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KMID : 0368120200500010052
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Korean Circulation Journal
2020 Volume.50 No. 1 p.52 ~ p.68
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Comparison of First-Line Dual Combination Treatments in Hypertension: Real-World Evidence from Multinational Heterogeneous Cohorts
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You Seng-Chan
Jung Sung-Jae
Swerdel Joel N.
Ryan Patrick B.
Schuemie Martijn J.
Suchard Marc A.
Lee Seong-Won
Cho Jae-Hyeong
Hripcsak George
Park Rae-Woong
Park Sung-Ha
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Abstract
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Background and Objectives: 2018 ESC/ESH Hypertension guideline recommends 2-drug combination as initial anti-hypertensive therapy. However, real-world evidence for effectiveness of recommended regimens remains limited. We aimed to compare the effectiveness of first-line anti-hypertensive treatment combining 2 out of the following classes: angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor blocker (A), calcium channel blocker (C), and thiazide-type diuretics (D).
Methods: Treatment-naive hypertensive adults without cardiovascular disease (CVD) who initiated dual anti-hypertensive medications were identified in 5 databases from US and Korea. The patients were matched for each comparison set by large-scale propensity score matching. Primary endpoint was all-cause mortality. Myocardial infarction, heart failure, stroke, and major adverse cardiac and cerebrovascular events as a composite outcome comprised the secondary measure.
Results: A total of 987,983 patients met the eligibility criteria. After matching, 222,686, 32,344, and 38,513 patients were allocated to A+C vs. A+D, C+D vs. A+C, and C+D vs. A+D comparison, respectively. There was no significant difference in the mortality during total of 1,806,077 person-years: A+C vs. A+D (hazard ratio [HR], 1.08; 95% confidence interval [CI], 0.97?1.20; p=0.127), C+D vs. A+C (HR, 0.93; 95% CI, 0.87?1.01; p=0.067), and C+D vs. A+D (HR, 1.18; 95% CI, 0.95?1.47; p=0.104). A+C was associated with a slightly higher risk of heart failure (HR, 1.09; 95% CI, 1.01?1.18; p=0.040) and stroke (HR, 1.08; 95% CI, 1.01?1.17; p=0.040) than A+D.
Conclusions: There was no significant difference in mortality among A+C, A+D, and C+D combination treatment in patients without previous CVD. This finding was consistent across multi-national heterogeneous cohorts in real-world practice.
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KEYWORD
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Hypertension, Antihypertensive agents, Angiotensin receptor antagonists, Calcium channel blockers, Diuretics
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